Coronavirus - The Basics

Angus Parker

I have to be honest - I've been ignoring the whole coronavirus news for the past couple of months. I knew that it had something to do with Wuhan in China, and I knew that it has spread around the world over the past few weeks but I really didn't have much knowledge beyond what I had heard on the news.

Today, I finally decided that, as a doctor, I should try to improve my understanding of what is turning into a global health concern. I hope this blog post will help answer some of the questions that I've had over the whole situation in the past few weeks and provide some form of explanation.

What the hell is this coronavirus thing and why is it a big deal?

Okay so there's two questions there. What is coronavirus? And why is it a big deal?

Coronaviruses are a family of viruses. This 'coronavirus' that everyone's talking about is a specific type of coronavirus that we've called SARS-CoV-2 coronavirus which stands for Severe Acute Respiratory Syndrome coronavirus 2, but everyone's just calling it 'coronavirus'. And the disease that it causes is called, unsurprisingly, Coronavirus Disease 2019, or COVID-19 because that sounds more cool.

More interestingly, it's a respiratory virus that we think originated in bats, and then somehow it spread to humans and the first few cases were in a city called Wuhan in mainland China. But... since January 2020 it's spread from Wuhan in China to loads of other places and it's now a Big Deal.

Why is it a big deal?

It's a big deal for 3 reasons. (1) It's affecting loads of people, and (2) It has quite a significant mortality rate, and (3) It's probably the worst outbreak of its kind in living memory. As of 6th March 2020 when this video's being filmed, there are over 100,000 confirmed cases of the infection, of which around 80,000 are in mainland China. There are 3,460 confirmed deaths, and again the majority are in the Hubei Province in mainland China.

But it's not just affecting China. It's a disease caused by a respiratory virus that spreads in droplets in the air, and because of how interconnected the world has become, there are infected people in over 80 countries across the globe. So in South Korea we've got 6500 confirmed cases, in Iran we've got nearly 5,000 in Italy nearly 5,000 and so on. And remember, these are just confirmed cases - ie: people who have been tested for the virus and have tested positive. There are probably more, possibly thousands, infected by the virus who haven't been tested, or who's symptoms have been so mild that they haven't noticed they've got it.

But these numbers - 100,000 infected, 3,000 dead. Those are hard numbers to appreciate in isolation. So let's compare them to similar epidemics in the past.

If you're a boomer like me, you might remember the SARS epidemic in 2003 again caused by a coronavirus. That affected around 8,000 people and killed 800 over an 8-month period. There was another coronavirus epidemic in 2012 that got less press attention from what I remember, the MERS epidemic that affected 2500 people and killed 861. Now so far, COVID-19 has affected 100,000 people and killed 3500 but this mortality rate, of 3.5%, is less than the 9.43% of SARS, and a lot less than the 34.5% mortality rate of MERS.

But... the problem is look at this other graph, again from the NBC website.

The spread of this virus is far greater compared to the spread of SARS or MERS. In just 2 months, COVID-19 has infected 100,000 people. It took MERS a whole year to infect just 200.

YET, it's worth bearing in mind as well, that the standard flu, which is also caused by a respiratory virus, kills around 400,000 people per year worldwide and we don't really bat an eyelid over that.

So that's why this coronavirus thing is a big deal - it's spreading quite fast and it's causing a number of deaths, and even though 3.5% is a lot less than 10% and 35%, 3.5% of millions of people that could potentially become infected, could cause significant issues.

Okay so I understand why this is a big deal. But realistically, what are my chances of getting it?

Well, depends where you are. The virus spreads, we think, through water droplets in the air. So to catch it, you have to either breathe the same air as someone who's got it, or you've touched something that has the virus droplets on it and then you've touched your mouth or nose or licked your hand or whatever and now it's in your system.

So, to get it you have to come into contact with someone else who's got it. And therefore, if you're in the UK for example, your chances of getting it are very small. Out of a population of nearly 70 million, just over 200 people have been infected and so that's a pretty small risk, with the caveat that these numbers are just the confirmed cases, and as I said earlier, there could be people roaming around who've got the virus but don't know they have it.

But in any case, your chances are pretty low.

Your chances get a lot higher if you've travelled to a country, or actually, if you live in a country, where there are more cases. So if you're in the UK for example, and you've recently been to China, or...

Cambodia

China

Hong Kong

Iran

Italy

Japan

Laos

Macau

Malaysia

Myanmar (Burma)

Singapore

South Korea

Taiwan

Tenerife – only the H10 Costa Adeje Palace Hotel

Thailand

Vietnam

...then your chances of getting it are higher because you're more likely to have come into contact with someone else who might have had the virus.

Let's say I do catch coronavirus. What would happen to my body, and what are my odds of surviving it?

Firstly we probably shouldn't call it coronavirus, we should probably call it COVID-19.

Secondly, to answer your question about what it does to the body, it's quite similar to other respiratory viruses, like the common cold or the flu, in that it can cause you to have a cough, fever, shortness of breath, muscle aches. From what we know so far, around 80% of the cases are mild, and only around 1 in 6 people become seriously ill and have trouble breathing.

And secondly, to answer the question, your chances of surviving COVID-19 depend a lot on how old you are and how many other health problems you've got. Overall, as we've mentioned, of the 100,000 people that have been infected, 3,500 have died, so that's a 3.5% mortality rate. But again, we know that in approximately 80% of the cases, the symptoms are mild and many people might not even realise that they have had it, and so the actual mortality rate is probably less than 3.5%. In fact, Chief Medical Officer for England, Professor Chris Witty, says that the overall mortality rate is probably lower than 1%.

But, take a look at this graph from the NBC News website:

It's comparing COVID-19 with SARS and MERS as before. And we can see here that your chances of dying increase the older you get, with people over 80 being particularly vulnerable, although even then The Guardian estimates that over 90% of over-80s who get infected with the virus will survive. But we do know that if you've got other health problems including preexisting respiratory disease, diabetes, heart disease or immunodeficiency, that your chances of dying from are a lot higher than someone who's young, fit and has no medical issues.

And, it's also worth mentioning - if you get COVID-19, the chances of surviving depend on geography too in terms of how good the healthcare system is in each nation. In the UK, we have the National Health Service and so if myself or my mum or my grandma were to get COVID-19, we'd most likely survive. But, if we were poor and living in a rural part of a nation without access to a similar healthcare system, our chances of dying from COVID-19 would unfortunately, be higher.

But how do people survive it? Do we have a cure or a vaccine?

Okay well there's 3 questions there. Firstly how do you survive it. Secondly do we have a cure. Thirdly do we have a vaccine. Let's tackle all of them.

Firstly, how do you survive it? For most of us, and for the 60,000 people who've recovered from the disease, our body's immune systems are pretty good at dealing with most invaders. Hence, after a few weeks, our body will probably fight it off naturally. The problem is that because it affects the lungs, it can affect our breathing, especially if we're old, or we have preexisting health problems. If it affects our breathing substantially, we might die before our body has a chance to fight it.

But, the good news is that even in that situation, we can have 'supportive treatment' in hospital. The most legitimate version of this is mechanical ventilation or enhanced ventilation in an intensive care unit. The idea is that if our lungs are suffering, we can get hooked up to a ventilator, or a 'life support machine', and that ventilator can help support our breathing until our body has a chance to fight the virus naturally. The issue, of course, is that if you're somewhere where this sort of intensive care treatment doesn't exist, you wouldn't have a machine and a team of medical professionals supporting your breathing, so you might well die of the disease before your body has a chance to fight it off.

But surely we can give them medication or something to help cure the disease?

Well, not exactly. We don't have a cure yet. But we've got drugs that we know work against other types of viruses, and we've got ongoing trials in China mostly, but also in the US and other countries, where people infected with the virus are being given anti-virals to see if they'll help. At the moment, it's too early to say.

Some drugs that might help are Kaletra (which is a combination of 2 anti-HIV drugs), and remdesevir, which they tried on Ebola patients in West Africa back in 2013 and 2016. And some Chinese doctors are apparently trying chloroquine, which is a cheap anti-malaria drug that could potentially help, and if it does that would be really useful for low-income countries. (Source: The Guardian).

What about a vaccine?

We don't have a vaccine against this type of coronavirus. We're working on it, but the general consensus is that it will be at least 12-18 months before we can get a vaccine that works.

Right. So, I now get what coronavirus is (it's a virus that started off in Wuhan in China but now's spread all over the world), and why it's a big deal (mainly because it's spread really fast and can kill people). And I understand that my own chances of catching it are pretty low, and even if I did, chances are I'd probably survive it especially if I'm young, healthy and living in a country with a decent healthcare system, even though we don't have a cure or a vaccine for it. Is that all correct?

Yes, that's right.

So why is everyone worrying? Is there any reason to panic?

Well, no, there's no reason to panic and panicking wouldn't be the right response. There's a hash tag going around that's #alertnotanxious. I think that's a really good way of looking at it. Alert, not anxious.

I can see why people are worried, especially if you're living in one of those countries where there's a large number of cases or if you or your loved ones are elderly, with medical problems, or if your country's healthcare system isn't that reliable - I can see why you'd be worried.

But if it's any consolation, firstly we need to remember that the normal flu infects approximately 40 million people per year and kills 400,000 and no one really panics about that. And, from the information we've got so far, it seems like the majority of cases will be mild, and we've got the whole world working together and so hopefully a solution can be found rapidly. In the meantime, there's a lot we can do to minimise our own risk of infection, or if we've got the virus, our risk of infecting others.

Oh really? What can we do to protect ourselves from the disease?

Well, there are a few things.

Firstly, we should all be working to reduce the spread of the virus - through simple acts like washing our hands with soap and water, or hand sanitiser, whenever we're doing things like eating food, or sneezing or coughing, or when we get into work or arrive home, because if we do happen to have picked up the virus particles en-route, we don't want them to get into our lungs. The classic advice to avoid touching your face is also relevant.

If you think you might have COVID-19, ie you've got symptoms of the flu (like fever, coughing, shortness of breath etc) and you think you've come into contact with someone else who might have had it, then you should follow your own country's advice on the topic. In the UK for example, we've got the NHS 111 Coronavirus service which tells you what to do, and outside many hospitals now they've got COVID-19 pods or drive-through stations where you can go there and get tested for the virus. And if you've got the virus, and it's mild, you just self-isolate yourself for a few weeks - i.e you don't go to work or school or public places to avoid spreading it around, or if it's affecting your breathing then we bring you into hospital in specialist wards to help support your breathing while your body fights off the infection.

I don't know how other countries are dealing with that, but check the internet and there'll probably be governmental advice about what to do.

What about face masks?

Face masks, now there's a question. There is a common misconception that face masks help protect you from catching it. Whilst some specialist face masks can, the advice from the WHO is to only use them if you have/think you have the virus to avoid spreading it. The WHO have advised people NOT to buy or use them if they do not have the virus because there is a worldwide shortage of face masks, and there's no evidence to suggest that face masks are actually useful outside of a hospital setting. So the advice is probably to avoid using them.

So that was the basics - but presumably there's a lot more to understand about what's going on with COVID-19 and why the media's talking about it all the time?

Yes you're right - we've just covered the basics here. There are many more stories and issues related to and arising from the virus from around the world.

The social and economic impact of the virus has already been widespread. For instance, stock markets around the world plunged in response to the crisis and we've seen major events cancelled and flights to entire countries stopped.

From an academic, historical and economic point of view, this has been quite an interesting outbreak, but let's not forget that this is a very real disease affecting real people around the world. The situation is constantly evolving and things could become more serious, BUT we should be alert, not anxious. There are things that we can do to help reduce the spread, like washing our hands regularly, and recognising the signs and symptoms, so that we can follow medical advice and self-isolate - all of which can help prevent this outbreak becoming a more serious global crisis.

So, that was an overview of the basics of COVID-19, the disease caused by the coronavirus that has shaken the world in 2020. If you've got any comments or corrections about anything we've said here, do please leave them down below in the comments section. Remember, stay alert not anxious.